Botox May Prevent Some Migraines

MONDAY Feb. 15, 2010 -- Botulinum toxin type A (Botox), the drug that can temporarily erase wrinkles, may also help prevent some types of migraines, a small study suggests.

Specifically, Botox may help reduce the recurrence of those migraines people describe as crushing or eye-popping, otherwise known as ocular migraines. However, the treatment does not appear to work for migraines that are experienced as pressure inside the head, the researchers added.

"In a previous study, neurologists discovered that most patients with imploding and ocular headaches responded to botulinum toxin A injections with a reduction of their headache frequency, while the majority of patients with exploding type migraines did not respond," said lead researcher Dr. Christine C. Kim, a dermatologist in Encino, Calif.

"We tested this hypothesis in a cosmetic dermatology setting, using botulinum toxin A doses that were much lower than what is typically used by headache specialists, and found similar results," she added.

The report is published in the February issue of the Archives of Dermatology.

Kim's group looked at 18 patients who were already going to have Botox injection for cosmetic reasons, but who also suffered from migraines. Among these patients, 10 had the type of migraine described as feeling crushing or eye-popping, like "someone is pushing a finger into an eye."

In addition, nine described their headaches as exploding headaches, feeling like their head is going to explode or split, or pressure is building up. Several patients had more than one type of migraine.

Within three months after Botox treatment, 13 patients saw a reduction in migraine pain. These included 10 with imploding or ocular migraine and three with exploding headaches. The six patients who did not respond to Botox all had exploding migraine.

Patients who responded to Botox saw their migraines reduced from almost seven days a month to less than one day a month. Among those with exploding migraine, headaches were reduced from 11.4 days a month to 9.4 days a month.

Why Botox, which paralyzes muscles, reduces migraine isn't clear, the researchers said. It may work by blocking pain receptors or reducing inflammation, they noted.

"While our results are preliminary, we are hopeful that our findings may eventually help researchers determine how botulinum toxin A injections prevent migraine pain, which patients will respond favorably, and what the proper doses and injection locations should be," Kim said.

The study was funded in part by Allergan Inc., the maker of Botox.

Botox has been tested before as a treatment for migraine, but was found wanting. In 2008, guidelines from the American Academy of Neurology said Botox should not be used to treat migraine because there was no evidence that it was beneficial.

"While Botox is not a first-line therapy for migraine prophylaxis, more research in this area may reveal that it can work to treat a unique portion of the migraine-suffering population," Kim said. "Botox is not considered the standard of care for preventing migraines, but it may be an alternative for some patients who do not respond to standard prophylactic medications."

Dr. Richard B. Lipton, vice chairman of neurology and director of the Montefiore Headache Center at the Albert Einstein College of Medicine in New York City, agreed: "Some migraine patients respond to treatment with botulinum toxin very dramatically, while others do not respond."

"Identifying the migraine patients who respond to toxin has long been a holy grail in headache medicine," he added.

Though this study is small, when combined with other evidence, it strongly supports the idea that patients with imploding headache respond to Botox treatment, Lipton said.

"Two recent double-blind studies show that patients with chronic migraine, with headaches 15 or more days per month, also respond to treatment with botulinum toxin," he added. Lipton noted that he has also received funding from Allergan.

Another expert, Dr. Gretchen E. Tietjen, chairwoman of neurology and director of the Headache Treatment and Research Program at the University of Toledo Medical Center in Ohio, said that while Botox is not a first-line treatment, she does refer some of her migraine patients.

"Maybe 50 percent of the people I refer for Botox tell me they really think it helped them," she said. "It's a select group of patients I refer. Usually, it's people where I have tried every medicine I can think of and it didn't work."

Tietjen noted that many insurance companies won't pay for Botox treatment for migraine.

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